Psychoanalytic Dialogues, 19:723733, 2009 Copyright Taylor & Francis Group, LLC ISSN: 1048-1885 print / 1940-9222 online

e DOI: 10.1080/10481880903381905

Termination as Necessary Madness

Sue Grand, Ph.D.
The NYU Postdoctoral Program in Psychoanalysis, New York, NY

The author offers an intensive clinical study, in which the paradox of termination is illuminated. For this patient, termination repeats the schizoid problem for which he arrived in treatment. The fear of closeness is confirmed by the knowledge that closeness will inevitably lead to loneliness and loss. This treatment dilemma opens up an inquiry into the original formulation of the analytic situation. The author proposes that the structure of psychoanalysisintimacy entwined with the severing of intimacymay conceal a need-fear dilemma which lies at the heart of our practice. I propose that this dilemma has always been gendered. Resistance to termination has been feminized, and a willingness to terminate has been masculinized.

David has been in treatment for about 5 years. For 3 years, there was an ordinary rhythm to his analysis. He was regular in his appointments, and in his payments. In the last 2 years we are engaged in analysis interruptuswe meet, we stop meeting for several months, we meet again for a series of sessions. We are in our fourth cycle of this pattern. We stop, we resume, we stop. Each time, we talk about attachment and separation, about the limits, and the possibilities, of our relationship. He talks about extra-analytic contact, and post-analytic contact, and the peculiarities of the analytic situation. He came to psychoanalysis because he wanted to be able to love full out. But in psychoanalysis, loss is immanent to love. Desire is awakened, and then, it is frustrated. Bonding is fulfilled, and then, it is severed. In all of its iterations, analytic love implicates grief. Every opening of the heart is shadowed by termination. The celebration of intimacy, the immanence of loss: this is the paradoxical core of psychoanalysis. David has been confounded by this paradox since the beginning of his treatment. Analytic boundaries liberate and secure him. They free him to explore his feelings in the transference. What he feels isnt pretty. But if he can do this with me, he might be able to love full out. Wife, children, friends: perhaps he could really be present with them. Perhaps he can really be present, inside himself. Moving through his world, David exudes warmth, humor, enthusiasm, and generosity. But his interior is remote. He can never fully feel others affection for him, and he can never really give his full affection to others. For David, analysis is hope. At the end of each session, that hope turns to despair. The hour is up: he feels that I am evicting him from my mind, and my heart. To David, this is a small death. It foreshadows a larger one. He anticipates a more permanent eviction: the end of his treatment. For several years, my clock seemed to regulate our bond. But it also awakened him from numbness. For much of the session,

Correspondence should be addressed to Sue Grand, Ph.D., 35 West 9th Street, 1B, New York NY 10011. E-mail: dr_sue_grand@yahoo.com

724

GRAND

he would try to be real. He would tell me about childhood, talk about his wife, and analyze dreams and erotic conflict. But he was just telling stories; he couldnt feel. Then weeping would erupt when his hour was over. His tears were attended by a visceral memory. I wanted to open this up. But all I could do was close it off. I made him leave while he was crying. I seemed cold and rigid. He felt greedy, and hurt, and deserted, and enraged. He hated my distraction and inattention. He was jealous of my other children. He wanted empathy, limitless time, exclusive attention. At the end of every session, I became the detested object of his dependence. Vulnerability was coextensive with abandonment and termination. To me, these moments felt coercive, frustrating, and moving. He tried to steal time which wasnt his. He stone-walled my signals, and I had to push him out the door. His tears were a plea, an exploitation, and an accusation: How can you leave me when Im hurting? I thought you wanted me to feel! He would deposit himself inside of me when I was already half-gone. He deposited himself inside of me because I was half-gone. By the next session, his injuries were buried. They disappeared into the interval between meetings; they re-appeared again when he was leaving. We were never together when he was suffering, and we were never together in either his hate, or his need. I learned to function as his link, and his memory. At the beginning of our sessions, I would refer to our last ending. He recalled it, but he couldnt be in it, until the ending of the session. Then, he was in it again, and I was gone. In that phase of his analysis, my empathic function could only be formulated as a retrospective. My concern always seemed to be belated: it referred to an experience which had already been missed. When he really needed my empathy, I wouldnt give it. When my empathy was there, he couldnt receive it. All I could do was to signify the link between vulnerability and leave-taking. In this way, the transference instantiated desertion. But that desertion was kept inside a resilient parental mind, which could tolerate his hatred, and re-appear to contain him, in the next session. I kept his tears inside me, when he was gone. Gradually, his wound crept further and further into his hour. He wept when I was present. He felt his longing for dependence, and his dread of dependence, and the cold rage which was evoked by disappointment. He had an increased capacity for attachment, expressiveness, and object constancy. But every time his wound healed, it was ripped open by the prospect of termination. He was afraid to get well because getting well meant his final desertion, even though he knew he would decide when to stop. In this treatment, ending is both necessary, and impossible: it enlivens the dead baby inside of him, and it threatens to kill off the baby which has just been revived. For David, bonding is desolation, abjection, falling to pieces. His infant self suffers from the schizoid problem described by Winnicott and Guntrip. David is endangered by contact, and he is endangered by the absence of contact. He comes alive with a howl; he assaults the object of his attachment. From early childhood on, he sealed himself away from others, and he sealed others away from himself. Now, he is aging. He has been a prisoner of childhood for over 70 years. Before he dies, he wants to know what it is like to feel alive. And so, in the first 3 years of therapy, he went the distance. He wanted me to love him, beyond all others. He wanted to hurt me and soil me. He held me back from my next patient. If I took a minute to pee before his session, I could feel him smoldering. I could feel his desire for vengeance. In bad weather, I asked him to remove his boots in the waiting room. He was willful, he refused, he dripped snow and salt and mud on the rug in my office. He expressed his vengeance through the mess which he was making. He was afraid I wouldnt love a nasty, messy baby. Whenever there was a bad storm, we knew we were in for a tussle. I would insist that he take off his boots. He

TERMINATION AS NECESSARY MADNESS

725

thought I was fussy and rigid. But he was relieved that I didnt give in. I wanted to know what it meant to him, to willfully soil my rug. This opened up visceral memories, and sadistic fantasies. On another occasion, he ignored his fee negotiation, and sent me a reduced amount. In his next session, he made a pretense of innocence, and waited to see what I would do. In his life, David seemed kind, and he kept his cruelty hidden. In analysis, these gestures were the merest surface of something which had always been secret. Sometimes, his coldness was stunning. It was redolent of that inhuman aggression which Guntrip (1971) linked to the schizoid problem. When people loved him for his warmth, David felt loved for a false self. Hate and contempt neutralized his fear and dependence. But he was always lonely and hungry. When I inquired into his vengeance, he felt someone saw him at last. Most of our work reckons with this dead infant self. But hes a sophisticated patient: he knows he isnt my baby, and Im not his mother. He is a man of many parts, and he has multiple layers of conflict about getting close. Each of them is salient at one time, or another. Ultimately, he wants to know me, and to love me, as one real adult to another. Over the years, he draws closer to that ability. He feels more anxiety, and less numbness and contempt. His relationships have been improving. And then, our sessions were interrupted by money trouble. He wasnt working, and his wifes job changed, and she was making less. I reduced his fee, but it wasnt enough, although he could never say what enough would be. If he was my real baby, he wouldnt have to pay. But he isnt my real baby, and so, he has to go. Money trouble demarcates reality. It is the occasion for mourning what I am not. It erects a limit which refers to the final limit of termination. He cant afford treatment, but sometimes, he needs it. So he stops, he returns, and he leaves again. He is reassured that he can always find me in my office. It would be nice to think of this as a rapprochement phase of separation. But our contact doesnt feel like a secure but transient symbiosis; it doesnt feel like celebration, comfort, or re-fueling (Mahler). And it doesnt seem to have the joy, or the mastery, of Freuds fort-da game. We are certainly playing out something about disappearance and return. But we dont feel like were playing. There is a lot of warmth when we meet. Still, something appears to be stuck. Every departure is a knot which we cannot seem to unravel. Termination is a recursive problem. It signifies autonomy, growing-up, a capacity for ambivalent and imperfect love. But it also re-ignites his schizoid process. Bonding repeatedly turns into loss, and his infant self is returned to cold storage. In our literature, there has been considerable discussion of forced, delayed, or premature termination. In this treatment, we seem to be inventing serial termination, and I wonder why we need to invent it. Whenever he goes, I dont know if, or when, he will come back. Each departure seems temporary. But one of these exits could lengthen into permanence. Perhaps, in a year or two, we will realize that this was our termination. For the two of us, time has always been problematic. It has been the referent for the fleeting nature of human contact. Perhaps our goodbye can only be formulated as a retrospective. Ours may be an unfulfilled parting. We may only recognize it in the future, as something which has passed, without being shared. Or something may happen in his next series of sessions, which will produce an alternate ending. At this writing, we are not meeting. Our past is unresolved, and our future is ambiguous. I am isolated from him, and yet, Im thinking about him. Im certain that he doesnt think I think about him, when he isnt present. As Bonovitz (2007) suggested, David might like to think that I have been effected by our encounter. It would mean a great deal to him if he thought that, as Bass (2001) put it, the trajectory of both lives will not be quite the same for the encounter (p. 700). But David cannot really imagine that he has left any imprint. He thinks that the longer hes gone, the more he will be forgotten.

726

GRAND

To me, he is actually illuminated by his absence. In the passage of time, our relationship unfolds, in my imagination. It accrues new dimensions. After I have been thinking about him for awhile, he re-appears, in real time. When we meet, neither of us knows what we are doing, or for how long. For both of us, attachment, mentalization, and separation are in a puzzling state of commentary and suspension. What does this say about this particular analysis, and what does it tell us about the analytic situation?

THE NECESSITY, AND THE PARADOX, OF ENDING In my view, this enactment is particular to this dyad. But it also points to an impossible knot in our impossible profession. Termination is not the final phase of an analysis. It hovers over every session, even if, as Slochower (2006) suggested, we construct a mutual illusion of timelessness in our work. In psychoanalysis, the capacity to love has a privileged, and contradictory, status. Intimacy is a hard-won and complicated achievement. When that intimacy is established, we end it. As Davies noted, there is certain absurdity to this arrangement. Loss and separation are possibilities in every relationship. But where else do we embark on closeness, knowing that closeness guarantees loss? Where else do we work hard towards a goal, knowing that grief is an inevitable feature of success? This is the contradictory core of the analytic situation. Slochower (1998, p. 24) put it succinctly: The analytic relationship terminates just as its getting good. When the treatment is effective, the relationship is supposed to end. There is a taboo about having post-analytic relationships. In the dissolution of the transference, the relationship is supposed to dissolve. In these conditions, it is no surprise that the work proceeds slowly. It is a wonder that patients open themselves up at all. Of course, there are worthy arguments for the analytic relationship ending. Most of these arguments are on behalf of the patient. But without endings, analysts would surely go mad from entropy and boredom. Just imagine if we spent decades with the same handful of patientsno one new coming, and no one leaving, and no hope for change or new stimulation. The same holds true for our patientsimagine that they stayed with their analyst, until their analyst died or retired. They might start to wish the analyst would hurry up, and die. All of us have had stultifying experiences, in which an analysis never seems to end. When patients and analysts hold onto each other for too long, vitality stalls, and the treatment itself can become its own pathogen. But most analytic dyads come to a moment of departure, in which analyst and patient go their separate ways. In many treatments, there is an organic letting go when the work seems to be done. In other treatments, there is a bumpy road to departure. In either case, there is much to be said for living through the experience of love and loss, relinquishing idealization, internalizing analytic function, discovering autonomy, reckoning with our existential condition, and turning ones gaze towards other relationships. In analysis, there are always boundaries, limits, taboos. These vivify affect and desire; they illuminate intra-psychic and inter-personal process; and they should secure the patient from the personal needs of the analyst. Termination is the ultimate boundary in analysis. It is implied when the first session draws to its end. For many reasons, termination is both necessary and inevitable. Still, there is something crazy about the way we think about our ending. If closeness guarantees loss in psychoanalysis, why do we pathologize the patients fear of intimacy, instead of hailing it as a healthy defense? Which one of us is mad? Why have we constructed such a peculiar treatment paradigm, in which we valorize

TERMINATION AS NECESSARY MADNESS

727

intimacy and embed intimacy in loss? Why is the analytic ideal (Slochower, 2006) of termination unchanged, when we rarely live by our own rules? As patients, many of us have continued contact with our analysts. As analysts, we hold onto to our patients for too long (Lionells, 2008). We have a professional heritage of forced terminations, and delayed terminations (see Novick, 1997), and we have constructed analytic institutes in which we never really lose our analyst. According to Levenson (1976), adolescents and young adults end their therapy when they reach escape velocity (p. 339). It seems to me that psychoanalysts rarely reach escape velocitywe may fight with our parents, but we tend to stay home with them. Nonetheless, we continue to espouse a neat phase of termination. We have begun to admit that we rarely achieve this, and we have an expanding literature which asks why we cant do it (Bergmann, 1997; Novick, 1997). But we still expect our patients to navigate our contradictions. We fail to see their resistance to intimacy as iatrogenic. What does this say about our professional unconscious? These questions become more possible in an era in which we are recognizing the prevalence of attachment disorders. According to Howell (2005) the most frequent underpinning of PTSD is a disorganized or insecure attachment. Psychoanalysis originated as a quasi-medical treatment; its methodology was interpretation, and it excised mental illness. Symptoms were rooted in oedipal pathology. Until recently, we didnt really know that we were treating trauma. As long as symptoms were linked to oedipal conflict, our treatment structure was an accurate mirror for our theory of psychopathology. To resolve illness, transference love had to be awakened, relinquished and mourned. To love out there, idealizing, incestuous love had to dissolve inside our office. Once the illness melted away, so did the relationshipeven though, it didnt. In contemporary psychoanalysis, we are less preoccupied with oedipal wishes, defenses, and gratifications. We are more concerned with the problems of trauma, attachment, fragmentation, and dissociation. In every theoretical orientation, we acknowledge the interactive relationship between patient and analyst. There is no sharp distinction between the real relationship, and the transference. We study the totality of the dyad, and have complex conversations with multiple self-systems. Now that we see the analytic dyad as a space of asymmetrical mutual influence (Aron, 1997), perhaps we can see the contradictions inherent in our own treatment structure. Perhaps we can admit to our own attachment problems. Maybe we can study the way we have written them into our law.

INTERPRETING TERMINATION AS A DREAM In this spirit, I would like to propose something radical. I would like us to suspend, for a moment, all of our assumptions about treatment. The analytic situation was a brilliant invention. It is an idyll of experience, which stands apart from all other human relationships. It has remarkable healing power. Without endings, this healing power would be compromised. Nonetheless, we can subject the analytic situation to a form of radical inquiry. We can examine our treatment structure the way we examine a patients dream. When we analyze dreams, we honor the plasticity, and the inventiveness, of the unconscious. Since the mind can invent anything while it is asleep, we allow ourselves to ask why the mind has constructed this particular set of images, here, now. Lets try turning the same methodology on ourselves. Once, there was no psychoanalysis. The human mind invented analytic praxisof all the shapes which treatment might have taken, why have we imagined this particular analytic structure?

728

GRAND

As analysts, we believe that dreams are multiply determined. They are elaborations of history. They are communications about contemporary predicaments. They are compromise formations; they serve many masters, and have progressive and defensive functions. To excavate their meaning, we suspend linearity and reason. We enter a hermeneutic labyrinth, which has intra-psychic, inter-personal, and social features. Again and again, we begin our inquiry by asking why this, here, now. Each time we ask, we get another answer, and open up another question. What would happen if we turned this lens on our treatment structure? What if we embraced our resistance to termination, and asked what this resistance tells us about our professional history, and our contemporary predicament? Perhaps we would reveal the progressive and the defensive functions of termination, and illuminate its intra-psychic, inter-personal, and social functions. To open up such an inquiry, we must notice the obvious. In constructing psychoanalysis, we have conceived an intimate pursuit with ruptured bonding at its core. We have valorized a proper ending, we create training and institutes in which there is no ending, and we critique ourselves for failing to adhere to the law of termination. We instate our own taboos, and then, we break them. Then we reify our conventions, extrude our own subversion, and double-bind our patients. Why did we invent a practice which creates, and ruptures bonds? Why must our own post-analytic attachments be illicit, and why do we forbid them to our non-analytic children? We have begun to study our own contradictions, transgressions, and resistances. But the termination literature only examines the defensive function of these resistances and transgressions. It doesnt reveal the progressive function of transgression, and it never permits these transgressions to query our taboos. The termination literature is implicitly tilted towards making us better citizens, who adhere to the law. In my view, our resistance to termination is not just a defensive evasion of loss. It is a pathway towards knowledge, a new prescription for healing. In our early oedipal focus, I believe that we put our own schizoid problem into cold storage. Through our own enactments, we reveal that problem, and try to repair that problem, and allow it to enter our professional consciousness. Oedipal theory was a brilliant formulation, and it continues to have curative resonance. But oedipal theory also provided excellent cover for a practice in which we invite, and undo, closeness. It revealed one form of conflict, while enacting another. Now that we appreciate the existence of multiple self states, we can retrieve our own dissociated self-other configurationsconfigurations infused with fragmentation, disordered attachment, and developmental arrest. If we look at the contradictions between what we say, and what we do about termination, any good analyst would think weve got a problem with intimacy. We seem to be expressing the longing for dependence, and the dread of dependence. Our law privileges autonomy, and our actions create fusion. When we act out like this, we are formulating a protest. We are pointing ourselves towards a new therapeutic. Like our patients, we have fissures in our capacity for intimacy and attachment. Like our patients, we cherish the hard-won adult relationship which emerges in psychotherapy. And like our patients, we have inherited a world view which devalues dependency, and equates independence with maturity, mastery, and strength (see Layton, 2004). We have all been under attack by gendered splitting: only girly-men, like Woody Allen, go on needing their psychoanalyst. Real patients are like Clint Eastwood: they grow up and get over it; they get going, and they know how to go it alone. No wonder we enjoy outing our patriarchal forebears, who endorsed termination, and then, mucked it up. When Novack reveals the behavior of Freud and his followers, we love it. In private, our patriarchs were girly-men about separation, attachment, and loss. They were enmeshed, and incestuous, and needy, and wounded; they were rejected and rejecting.

TERMINATION AS NECESSARY MADNESS

729

Lets not trivialize our pleasure in this analytic gossip. In this pleasure, we find the whiff of social rebellion. As Layton (2004) noted, we have been made sick by this excessive valence on independence. This valence has contributed to the need-fear dilemma. It has made us counter-phobic about our need for other. It has made us disdainful of the needy other. We drop bombs in our intimate relationships, and we drop bombs on the world stage. Perhaps psychoanalysts should reconsider healthy inter-dependence, even though we dont know exactly what that is, or what it looks like at the end of analysis. Given the cultural prevalence of attachment disorders, I think we need to re-visit love, inter-dependency, and the nature of what Gerson called the embedded self. As Sullivan (p. 53) once put it, We are all much more simply human than otherwise. As analysts, we seem to want what most adult children seem to want: to grow up and individuate, and to be able to keep our good enough parents. As practitioners devoted to an intimate practice, we may actually want this much more than some of our own patients. If we look at the way we arrange our institutes, we certainly seem to want to go on loving our parents, somehow, until death intervenes. If Freud hadnt had extra-analytic, and post-analytic contact with his patients, he wouldnt have had any colleagues, and there would have been no future for psychoanalysis. Our forebears may have been acting out their own attachment problems. But they also had a conflicted understanding that we need each other. What is curious, here, is the denial of that need, and the way we wrote that denial into our canon. In this discussion, I am moving back and forth from the study of a particular psychoanalysis and the study of psychoanalysis itself. Let us move back, for a moment, to the particularity of the analytic couple. Maturity, individuation, going-on-loving, and even death itself: these can take a multitude of forms in any given psychoanalysis. As Davies (2005) suggested in her paper on termination, they will take a multitude of forms within each psychoanalysis, because analyst and patient exist in multiple self-other configurations. Every analytic dyad will need to formulate complex and shifting positions about attachment, separation, and leave-taking. This can only happen if we listen to our resistances and transgressions, and allow them to query the law of termination. A recent Psychological Inquiry issue was devoted to the nature of the analytic love. In contemporary psychoanalysis, we have been increasingly open about what we are really doing, and what we are really feeling. We have already admitted to hating our patient (Coltart, 1986; Grand, 2000, etc.) and to desiring our patient (see Davies, 2005). Now, perhaps, we can turn to something which seems much more banal, even though it isnt. What is love in the analytic relationship, and what do we do with it, when therapy is finished? If we can ask this question, we might understand what David and I are doing, as he comes and goes, without going.

ATTACHMENT AND SEPARATION: THE PERPETUITY OF ENACTMENT With David, every break is framed as an interruption, and every interruption is precipitated by money trouble. He commits to a fee, and then, discovers that he cant (or wont) pay it. Fee reductions dont do it. He needs me to waive the fee, or slash the fee, even though he knows that hes not entitled. He cant ever seem to do anything about his finances; he wants me to solve it, and he knows this is his problem. We both know that the fee is functioning like my clock. It is the litmus test of love, the perimeter of attachment. If I really care about him, I wont care about my fee. As an adult, he knows that I do care about him, and that I am also working, and earning my living.

730

GRAND

David never seems to have agency, when it comes to leaving. He doesnt interrupt treatment because he wants to, but because he has to. He thinks he wants to stay. Once, he had an interesting solution: we could set up a post-termination annuity. He would pay a nominal fee now, while he was here. When he was finished, he would pay me in monthly installments. He would get to finish his therapy. And after he was gone, I would receive a modest income. To David, this was a fair proposal, in which everyones needs would be covered. He seems innocent, and he really means it. But to me, this is the latest move in a series of provocations. My coldness is always responsible for our separations. If I accepted the annuity, he could staybut it never occurs to me to accept it. He is in his 70s, he doesnt work, he has no savings, and he is reliant on the modest income of his younger wife. Why would I labor now and hope for payment later? Why should I pay for his fiscal irresponsibility? If he dies, am I really going to hold his wife accountable for his debt? I want to talk about the unconscious meaning of his offer; he wants me to consider it. Theres no getting around this one. I refuse, and try to explainbut I avoid mentioning his age, or his death. Ive disappointed him again, and once again, I seem to be pushing him out. Before he stops this time, we talk about the inventiveness of the annuity. From the beginning of our work, he has worried about our attachment. Is it reciprocal and authentic? Is it imaginary and one-sided? Could we ever be two ordinary people, who like, and know, each other? Can we have some kind of relationship after therapy? If I would agree, would he really want it? Ah, I said, but this annuity. You would be gone, I wouldnt see you, but you could secure your place in my mind, over many years. And you could reverse your own predicament. I could be the needy baby, waiting for my feed, dependant. You could take your revenge, if you wanted. He gets it, we laugh, he feels childish, I feel like Scrooge. He cries, he says goodbye, and then, he leaves. And I am left thinking about my relation to money. Am I more attached to my fee than I am to David? If that is true, what does it mean about me, about us, about the culture in which we are embedded? And how does it refer to the culture of Davids childhood? David was born to rich parents, just before the stock market Crash of 1929. His parents had been elegant; they were the elite of Brooklyn, and they lived in opulence. They had an anglicized name, and disdain for their poor Jewish relatives. Suddenly, they were bankrupt. Without wealth, they had, and were, nothing. They may have bonded to their infant prior to the Crash. Afterwards, they went dead, towards him and his brother, as well as to each other. In his sessions, he relives the desolation which followed the Crash. He would feel himself alone in his crib, in a dark room, with no one coming. As a toddler, he knows that he peed in bed and that he smeared his shit on the walls. Session after session, he is in that crib. When he visualizes someone, it is a threatening presence. Dripping mud on my rug, he senses parental rage about cleaning up his mess. In another visualization, he crawls through empty rooms, searching for mother. When he finds her, she is kneeling and scrubbing; she wont turn to look at him. After the Crash, all she does is hoard and clean. This imagery returns when I ask him to remove his boots, in the waiting room. Then later, they are in a cramped and dismal apartment. There is no privacy, or escape from each others bodies. There is one bathroom for four people. Someone is always peeing or pooping, while someone else is showering or dressing. Upper-class shame infuses this exposure. Genitals are always on display, but he has to pretend he isnt seeing them. When he looks, he feels perverse. There is nothing warm in this inter-mingling of bodies. He doesnt feel anyone loves him, or even, that they see him. His father is bitter, caustic, and broken. His mother is lonely. By day, he saw no evidence of parental closeness. At night he heard the grunts of sexual intercourse. Arousal seemed

TERMINATION AS NECESSARY MADNESS

731

cold, it was unwanted, and it seemed to hurt. Gradually, his mother turned to David for the affection she could not get from her husband. He wanted the embrace of a mother, but when she touched him, it was suffocating and repugnant. He remembers her seductiveness, as she undressed in front of him, in his parents bedroom. He stared at her breasts, and his look felt prurient and incestuous. He could never find a comfortable mother, whom he could touch, or who could comfort him. In mid-childhood, he tried to choke his mother. In adolescence, he set fires, got in fights, and ran away from home. He was afraid of being wanted, and he was afraid of being left alone. He wanted a woman, he was smothered by women, and he thought he would hurt them with his angry desire. In this family, money trouble foreclosed closeness, in every phase of development. Money glittered, it was elusive, and it eclipsed the human heart. It was the signifier for power and abjection; for craving and longing and loss. As a teenager, as a young man, and as an adult, it was the standard by which his mother measured him. He could make money, but he could never plan ahead, or conserve it. Of course, fees test our closeness. He keeps re-enacting the crash, and asking whether his analyst-parent can value something else about him, or sustain a bond. But if I am too compliant about fees, I become the clinging mother, who needed him too much, and wants to keep him for herself. If he goes, he loses his infant mother. If he stays, he is smothered. Termination is the perfect mirror for his need-fear dilemma. In his prior treatment, David was engaged in another knot about money, boundaries, and termination. For 20 years, he had a warm and fatherly analyst, who filled the hole left by Davids real father. Together, they focused on oedipal issues. They enacted attachment longings, and never analyzed those longings, or the need for some separation. In this treatment, David found himself as an artist, and he fell in love with his current wife. Something went very right, and very wrong, in this analysis. His first analyst seemed established, and secure, and generous: he accepted Davids paintings as payment, he went to his shows, he rarely ended the sessions on time. Love wasnt soiled by materialism. Love wasnt ruptured by artificial boundaries. Davids value wasnt defined by dollar signs. But the analysts looseness had terrible consequences. After 15 years of treatment, David discovered that his analyst was sleeping with a female patient. He confronted his analyst, who admitted it, with some regret. Now, apparently, that was all over. For a few sessions, David howled with rage, and betrayal, and jealousy, and fear. Then, they told themselves that this episode was over. David stayed in analysis, and slowly, the treatment went stale. He would lie silently on the couch, with his silent analyst behind him. My patient became unable to speak, and the analysts warmth became more and more remote. David was back in his crib, and no one was coming. Eventually, his analyst retired, and when they said goodbye, it was forever. David never told anyone about his analysts transgression, until he entered treatment with me. In our work, he needed to explore his erotic transference; and he was always frightened that I would violate our boundaries. All of this added extra layers of complication to Davids need-fear dilemma: his wish for contact and his dread of contact. Davids first analysis enacted attachment; it healed him; it aroused incestuous rage and anxiety; it betrayed him; it recreated his schizoid predicament, and then, it ended. Well, that didnt work, and we cant quite figure out what would. There are so many parts of him. All of them seem conflicted about staying, and going. Some of them need flexible boundaries, and some of them need those boundaries to be rigid. And then, there is a grown-up David, who knows about the ultimate end which is coming. He is in his late 70s. He is earthy, and funny, and enthusiastic. He has close friendships; he comes through for his friends. He is a thinker, and he likes to converse. We share political and social views. At the

732

GRAND

beginning of our sessions, we often have a good laugh. Despite his internal struggle, he is actually more present than most people whom I meet. And he knows that one day, he will die. Over the time I have seen him, hes had prostate cancer and a heart attack. He wont always be here. I like him. An accident of fate brought us together as analyst and patient. As his therapist, Ive seen the numbness with which he sealed his heart. I have watched him struggle, and open up. He got better, even though that meant that he might leave. Then, he had a heart attack. I went to see him in the hospital, and we talked about his heart. I asked him if he could really feel, and trust, the love of his friends and relatives. Without hesitation, he said yes. He knew his wife would not desert him, and he didnt need to keep her at a distance, or punish her for her comings and goings. He was touched that I was there, and awkward in my presence. We both knew that my presence was a partial answer to his question. I was there as his analyst. But I was also there as a friend, as one human being to another, in a time of crisis. After that, I didnt see him; he was on bed rest for 3 months. I called him once or twice to see how he was feeling. Then, he came back to treatment, and continued his cycle of coming and going. Each time, he would ask, who we might be to each other, if we ever finished. The infant inside of him will always want a mother. The dead baby inside of him is never fully healed. Now that infant has other objects, but his analysts have been his first parents. He may have finished analyzing the self who was in cold storage, but, as Annie Reich (1958) put it, analysis has been the first really reliable object relationship in the patients life (p. 236). We dont know if the transference will ever resolve. Anyway, he isnt finished with contact. And as a man facing death, it seems ridiculous to relinquish our good enough relationship, now that we have it. He imagines walks, casual and mutual conversationabout birds and gardens and the problems of local politics. He wants to get to know me, without the interference of our roles. I dont share his particular fantasy. Still, I think we might have found each other, as neighbors, in another setting. We attend the same community meetings, and are active in the same local projects. A friendly acquaintanceship might have developed between us. As analyst and patient, this would certainly be complicated, and perhaps, inadvisable. It might deprive him of an analyst, in the future, should he need me. If I spent time with him outside the treatment setting, it might trigger his fear that I, too, would breach the sexual boundaries with my patient. I cannot imagine being uninhibited in his presence. The smallest contact would carry the weight of his greater need, and my greater knowledge. We have no answers. We are secured by our boundaries, but we are not persuaded by the law. In my practice, he disappears, and re-appears. His self states cohere, they unravel, they have objects, they become objectless, they are little, they are big, and they are growing old. They want to go on loving, until death parts us, for the last time.

REFERENCES
Aron, L. (1996). Mutuality in psychoanalysis. Hillsdale, NJ: The Analytic Press. Bass, T. (2001). It takes one to know one, or whose unconscious is it anyway? Psychoanalytic Dialogues, 11, 683703. Bergmann, M. (1997). Termination: The Achilles heel of psychoanalytic technique. Psychoanalytic Psychology, 14, 163174. Bonovitz, C. (2007). Termination never ends: The inevitable incompleteness of psychoanalysis. Contemporary Psychoanalysis, 43, 229247. Coltart, N. (1986). Thinking the unthinkable in psychoanalysis. In G. Kohon (ed.), The British school of psychoanalysis: The independent tradition (pp. 185199). New Haven, CT: Yale University Press.

TERMINATION AS NECESSARY MADNESS

733

Davies, J. M. (2005). Transformations of desire and despair: Reflections on the termination process from a relational perspective. Psychoanalytic Dialogues, 15, 779805. Grand, S. (2000). The reproduction of evil: A clinical and cultural perspective. Hillsdale, NJ: The Analytic Press. Guntrip, H. (1971). Psychoanalytic theory, therapy and the self. New York: Basic Books. Howell, E. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press. Layton, L. (2004). Whos that girl? Whos that boy? Clinical practice meets postmodern gender theory. Hillsdale, NJ: The Analytic Press. Levenson, E. A. (1976). The aesthetics of termination. Contemporary Psychoanalysis, 12, 338341. Lionells, M. (2008). Personal Communication. Mahler, M. S. (1968). On human symbiosis and the vicissitudes of individuation. New York: Basic Books. Novick, J. (1997). Termination conceivable and inconceivable. Psychoanalytic Psychology, 14, 145162. Reich, A. (1958). A special variation in technique. In, Psychoanalytic contributions (pp. 236249). New York: International Universities Press. Slochower, J. (2006). Psychoanalytic collisions. London: Lawrence Erlbaum Books. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.

CONTRIBUTOR Sue Grand, Ph.D., is Faculty and Supervisor at the NYU Postdoctoral Program in Psychoanalysis, Faculty at the Mitchell Center for Relational Psychoanalysis, Faculty at the Psychoanalytic Institute of Northern California, and Faculty at the National Institute for the Psychotherapies. She is the author of The Reproduction of Evil: A Clinical and Cultural Perspective and of The Hero in the Mirror: From Fear to Fortitude. She is in private practice in New York City and Teaneck, New Jersey.

Copyright of Psychoanalytic Dialogues is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.